Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a doctor working in family medicine. Your next patient is Monk Keye, a 40-year-old female complaining of tiredness and low mood. Please take a history and perform a relevant examination.
Patient History:
Your name is Monk Keye, a 40-year-old female working as an office worker at HR of a company.
You have generally felt more tired and lowly for the past few months. You notice you have been gaining weight and feel embarrassed that you look fatter. You also feel stressed. When asked, you have been bruising a lot lately, and you have more "fat" on your face, back and neck and look rounder. When asked, you have stretch marks and weakness in your limbs. You have lost interest in sexual activity with your partner and have mood swings, making you argue a lot with him. Your menstruation has been becoming more irregular lately, but you think it's because you may be going to have menopause. You also have been drinking a lot of fluids lately as you always feel thirsty and urinate a lot as a result. Otherwise, eating and drinking well. You have poor sleep at the moment.
No headache/ visual problems or galactorrhoea. No previous fractures.
Ideas, Concerns, Expectations:
You think you might be having depression or just reaching menopause. You are concerned that these symptoms are affecting your life – work / social and, most importantly, with your partner! You hope to get married one day and don't want to be single again! You want to find out what is going on!
Past Medical History:
Hypertension, Ulcerative Colitis
Drug History:
On ramipril, omeprazole and on prednisolone you have been taking for a while
NKDA
Family History:
A thyroid disease, but you do not know which one.
Social History:
Don't smoke
Don't drink
Live with a partner
Independent at home
Examination Findings:
Round "moon" face with large fat build-up on the back of your neck and shoulders (buffalo hump). Your face is red and puffy (facial plethora). Acne. Central obesity. Abdominal Stiae. Reduced muscle mass in proximal limbs. Thin skin and bruising around limbs. Hirsutism may be present.
Differentials:
Cushing’s Syndrome
Hypothyroidism
Depression / Anxiety
Peri-menopause
Investigations: